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Individual

HOLLY A WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
(262) 434-5050
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9679
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100094369
WI
Enumeration date
10/17/2019
Last updated
10/24/2025
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